The outcomes of second haploidentical donor transplantation for graft failure in patients with severe aplastic anaemia.

This study aimed to evaluate the outcomes of second haploidentical hematopoietic stem cell transplantation (HID-HSCT) for patients with severe aplastic anaemia (SAA) who experienced graft failure. Twenty-one SAA patients with graft failure after first allogeneic (allo-) HSCT were enrolled, including 6 (28.6%) with poor graft function and 15 (71.4%) with graft rejection. Two patients developed primary graft failure after the second transplantation, and the cumulative incidence of neutrophil recovery was 81.0% ± 0.9%, with a median recovery of 13 days (range, 10-23 days). The cumulative incidences of grade II-IV and III-IV acute graft-versus-host disease (GvHD) were 19.0% ± 0.8% and 4.8% ± 0.2%, respectively. The cumulative incidences of chronic GvHD (cGvHD) at three and five years were both 24.5% ± 1.0%, with no severe cGvHD cases. The 5-year overall survival (OS) rate was 47.1% ± 11.0%, with a median follow-up of 2037.5 days (range, 863-3488 days) among survivors. Multivariate logistic regression analysis identified not changing a donor (P = 0.019) as the only adverse factor for graft failure after the second HID-HSCT. Moreover, changing a donor (P = 0.004), compatible donor-recipient blood type (P = 0.005), and patient age < 12 years (P = 0.038) at the second transplantation were significant predictors of improved OS. These findings suggest that a second HID-HSCT could be a feasible option for treating graft failure in SAA patients.